Spine Health and Diseases

What is Vertebral Body Tethering (VBT) for Scoliosis?

Vertebral body tethering is a fusionless surgical method used in the treatment of scoliosis (curvature of the spine), especially in growing children. While in traditional scoliosis surgeries, the vertebrae are corrected by being fixed with metal rods (fusion), this method preserves the mobility of the spine.

During the surgery, screws are placed on the convex side of the spine, and a tensioned tether is passed between these screws. This tether allows the curvature to correct over time by utilizing the spine's growth potential. As growth continues, the tension of the tether guides the vertebrae to grow in the correct position. One of the biggest advantages of this method is that it preserves the flexibility of the spine and allows the patient to return to daily life more quickly after surgery.

What is Scoliosis? Scoliosis Treatment

Scoliosis is a condition where the spine curves abnormally to the right or left. While a healthy spine appears as a straight line when viewed from the back, a scoliotic spine has an "S" or "C" shaped curvature. This condition usually becomes apparent during the rapid growth spurt of adolescence.

Causes: The cause of a large portion of scoliosis cases is not precisely known, and this is called "idiopathic scoliosis." It can also develop due to congenital spinal anomalies (congenital scoliosis) or as a result of muscle and nerve diseases (neuromuscular scoliosis).

Symptoms:

• One shoulder being higher than the other
• One shoulder blade being more prominent than the other
• An indentation on one side of the waist and a protrusion on the other
• Asymmetrical hips
• The body leaning to one side

Treatment: Scoliosis treatment varies depending on the degree of curvature, the patient's age, and the stage of bone development.

• Observation: For low-degree curvatures, the doctor monitors whether the curvature is progressing at regular intervals.
• Brace Treatment: In growing children and for moderate curvatures, the use of a brace may be recommended to stop the progression of the curve.
• Physical Therapy and Exercise: Special exercise programs are implemented to strengthen the muscles around the spine and correct posture.
• Surgical Treatment: In cases of severe curvature or when other treatment methods are inadequate, surgical intervention (fusion or fusionless surgeries) may be necessary.

Spinal Stenosis

Spinal Stenosis is the narrowing of the spinal canal through which the spinal cord and nerve roots pass. This narrowing creates pressure on the spinal cord and nerves, leading to various neurological symptoms. It usually occurs as a result of degenerative changes in the spine that come with aging (calcification, herniation, thickening of connective tissues).

Symptoms: Symptoms vary depending on the location of the narrowing (neck or lower back).

In the lumbar region (Lumbar Spinal Stenosis):

• Pain, numbness, tingling, and weakness in the legs
• Pain that increases with walking or standing and decreases with sitting or leaning forward (neurogenic claudication)
• Low back pain

In the cervical region (Cervical Spinal Stenosis):

• Pain, numbness, and clumsiness in the arms and hands
• Difficulty walking, balance problems
• In advanced cases, problems with bladder and bowel control

Treatment: The goal of treatment is to alleviate symptoms and improve the patient's quality of life.

• Medication: Pain relievers, anti-inflammatory drugs, and muscle relaxants can be used.
• Physical Therapy: Exercise programs are organized to strengthen muscles and increase flexibility.
• Injections: Epidural steroid injections into the canal can provide temporary relief by reducing swelling and pressure on the nerves.
• Surgical Treatment: In patients who do not respond to conservative treatments, have progressive neurological deficits, or whose quality of life is severely affected, surgical procedures (laminectomy, decompression) to widen the narrowed canal are performed.

What is Osteoporosis?

Osteoporosis, also known as "bone loss," is a skeletal system disease where bones become more fragile due to decreased bone density and deterioration of bone structure. This condition particularly increases the risk of hip, spine, and wrist fractures.

Causes and Risk Factors: Aging is the most important risk factor. Especially in women, the decrease in estrogen hormone after menopause accelerates bone loss. Other risk factors include genetic predisposition, inadequate calcium and Vitamin D intake, a sedentary lifestyle, smoking and alcohol use, certain medications, and chronic diseases.

Symptoms: Osteoporosis is often a "silent" disease and may not show significant symptoms until a fracture occurs. In advanced stages, a decrease in height, hunching (kyphosis), and widespread back pain may be observed.

Diagnosis and Treatment: The diagnosis is made with a bone mineral density measurement (DEXA). The aim of treatment is to slow down bone loss, increase bone density, and reduce the risk of fractures.

• Lifestyle Changes: A diet rich in calcium and Vitamin D, regular weight-bearing exercises.
• Medication: Various drugs that reduce bone resorption (bisphosphonates) or increase bone formation are used under a doctor's supervision.

Spondylolisthesis (Slipped Vertebra)

Spondylolisthesis is a condition where one vertebra slips forward over the one below it. This slippage can cause compression of nerve roots and low back pain due to abnormal pressure on the discs and facet joints between the vertebrae.

Causes:

• Degenerative: Wear and tear of discs and joints due to aging.
• Isthmic: Occurs as a result of a stress fracture in a part of the vertebra called the "pars interarticularis." It can be common in young athletes.
• Traumatic: Can occur after a serious injury or trauma.
• Congenital: May be due to a congenital anomaly.

Symptoms:

• Low back pain (especially increasing with standing and activity)
• Pain radiating to the legs (sciatica), numbness, and tingling
• Weakness in the legs and tightness in the hamstring muscles
• Difficulty walking

Treatment: Treatment is planned according to the degree of slippage, the patient's age, and the severity of symptoms.

• Conservative Treatment: Rest, pain relievers and anti-inflammatory drugs, physical therapy, and the use of a brace.
• Surgical Treatment: Surgical treatment is recommended when conservative treatment fails, the slippage progresses, or there are signs of severe neurological compression. In surgery, the pressure on the nerves is usually relieved, and the slipped vertebrae are stabilized using screws and rods (fusion).

What are Stem Cells?

Stem cells are master cells found in the body that are undifferentiated, can self-renew, and have the potential to transform into any type of tissue or organ cell in the body under the right conditions. Thanks to these properties, they play a key role in the repair and regeneration of damaged tissues and organs.

Types of Stem Cells:

• Embryonic Stem Cells: Found in the early developmental stages of an embryo and have the potential to turn into all cell types in the body (pluripotent).
• Adult Stem Cells: Found in various tissues of the body (bone marrow, adipose tissue, blood, etc.) and generally have the ability to turn into the cell types of the tissue they are in (multipotent).
• Induced Pluripotent Stem Cells (iPSCs): Obtained by genetically reprogramming adult body cells (e.g., skin cells) in a laboratory setting to acquire properties similar to embryonic stem cells.

Uses: Stem cell therapy is one of the most promising areas of regenerative medicine. In orthopedics, it is used to repair damaged tissue and accelerate healing in conditions such as cartilage damage, joint arthritis (osteoarthritis), and muscle and tendon injuries. The treatment is usually applied by isolating and concentrating stem cells taken from the patient's own body (from bone marrow or adipose tissue) and then injecting them into the damaged area.